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Stromal Luteoma of The Ovary: A Rare Case Presentation
Stromal Luteoma of The Ovary: A Rare Case Presentation
Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh,
Uttar Pradesh, India
ABSTRACT
Stromal luteoma of the ovary occurs mostly in postmenopausal females and is very rare. It is seen in all ages with
preponderance in the fifth and sixth decades of life. Abnormal vaginal bleeding is the most frequent presentation, but
endocrine symptoms and sometimes virilizing signs may also be observed. Symptomatology of features may differ
depending on the type of hormones secreted from the tumor cells. Stromal luteomas usually present with hyperestrogenic
symptoms, while Leydig cell tumors are mostly associated with hyperandrogenism. We present a case report of a 50-year-
old female who presented with postmenopausal bleeding and was diagnosed with stromal luteoma of the ovary on
histopathology.
S
tromal luteoma of the ovary occurs mostly in Stromal luteomas usually present with hyperestrogenic
postmenopausal females and is very rare.[1] Abnormal symptoms, while Leydig cell tumors are mostly associated
vaginal bleeding is the most frequent presentation, but with hyperandrogenism. However, in the NOS group,
endocrine symptoms and sometimes virilizing signs may hyperestrogenism may rarely be seen, as 25.0% of NOS
also be observed.[2] This tumor is surrounded by an ovarian tumors show no hormonal activity.[4,5]
stroma, entirely composed of luteinized cells devoid of
crystals of Reinke. Hyperthecosis of the ovarian stroma is We present a case report of a 50-year-old female who
often observed in this benign tumor.[3] presented with postmenopausal bleeding. She underwent
total abdominal hysterectomy with bilateral salpingo-
Sex cord ovarian tumors are a rare kind of ovarian neoplasm. oophorectomy and was diagnosed with stromal luteoma of
Steroid cell tumors accounting for 0.1% of all primary the ovary on histopathology.
ovarian tumors are a subgroup of sex cord ovarian tumors.[1,2]
According to the origin of the cells that generate the tumor, CASE REPORT
steroid cell tumors are classified into three groups: Stromal
luteomas, Leydig cell tumors, and steroid cell tumors, not A 50-year-old female presented in the gynecology clinic with
otherwise specified (NOS). complaints of abnormal vaginal bleeding for the past 4 years.
Transvaginal ultrasonography showed an endometrial
Stromal luteomas constitute 20–25% of all steroid cell thickness of 23 mm, with enlarged left ovary to 12 cm×10 cm
tumors.[2,3] It is seen in all ages with preponderance in the in size and atrophic right ovary. Endometrial curettage was
© 2020 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.
DISCUSSION
Stromal luteomas constitute 20.0–25.0% of all steroid
cell tumors and are always benign. These tumors show the
presence of small round to oval steroid cells in the ovarian Figure 2: High power of Figure 1. Hematoxylin and eosin ×40
stroma, whereas Leydig cell tumors are usually seen in the
hilus of the ovary.[4]
Young reported stromal luteomas mostly in postmenopausal the endometrial biopsy specimen.[5] Only 12.0% of the
women who presented with hyperestrogenic abnormal patients with stromal luteoma have androgenic symptoms.[6]
bleeding. Similarly, our case presented to the gynecology Stromal luteomas and Leydig cell tumors are mostly seen in
clinic with postmenopausal bleeding. The hyperestrogenic postmenopausal women, whereas NOS is mostly seen in the
state was confirmed on histopathological evaluation of young premenopausal age group.[6]
Microscopically, stromal luteomas may simulate Leydig cell tumor of the ovary in young lactating women with acute onset
tumors and theca lutein cysts. Leydig cell tumors are seen of severe hyperandrogenism: A case report and review of
in the hilus and contain steroid cells that include Reinke literature. J Med Case Rep 2010;18:180-2.
crystalloids.[7,8] Microscopic examination of stromal luteomas 3. Hayes MC, Scully RE. Stromal luteoma of the ovary:
A clinicopathological analysis of 25 cases. Int J Gynecol
shows stromal hyperthecosis in 92.0% of stromal luteomas,
Pathol 1987;6:313-21.
42.0% of Leydig cell tumors, and 23.0% of NOS.[8] Theca 4. Hayes MC, Scully RE. Ovarian steroid cell tumors (not
lutein cysts always present as a follicle in the stroma, but this otherwise specified). A clinicopathological analysis of
is not observed in stromal luteomas. Malignant melanomas 63 cases. Am J Surg Pathol 1987;11:835-45.
can mimic stromal luteomas and can be differentiated by 5. Roth LM, Sternberg WH. Ovarian stromal tumors containing
S100 and human melanoma black-45 immunoreactivity Leydig cells. II. Pure Leydig cell tumor, non-hilar type. Cancer
in melanomas.[9] We diagnosed our patient as a case of 1973;32:952-60.
stromal luteoma based on clinical, histopathological, and 6. Scully RE. Stromal luteoma of the ovary. A distinctive type of
immunoreactivity with an inhibin antibody. These tumors lipoid-cell tumor. Cancer 1964;17:769-78.
7. Sternberg WH, Dhurandhar HN. Functional ovarian tumors of
are known to be benign tumors, so surgical staging was not
stromal and sex cord origin. Hum Pathol 1977;8:565-82.
recommended. As in epithelial ovarian cancers, the treatment 8. Sternberg WH, Roth LM. Ovarian stromal tumors containing
of sex cord tumors is surgery.[10] Leydig cells. I. Stromal-Leydig cell tumor and non-neoplastic
transformation of ovarian stroma to Leydig cells. Cancer
Ovaries should be examined carefully with transvaginal 2013;32:940-51.
ultrasonography to reveal any accompanying ovarian 9. Young KM. Sex cord-stromal, steroid cell, and other ovarian
pathology in women with postmenopausal bleeding, and tumors with endocrine, paraendocrine, and paraneoplastic
stromal luteomas should be considered as a reason for manifestations. In: Kurman RJ, Ellenson LH, Ronnett BM,
the postmenopausal bleeding, even though they are rare. editors. Blaustein’s Pathology of the Female Genital Tract.
6th ed. New York: Springer; 2011. p. 826-46.
Nevertheless, the transvaginal ultrasound is the most sensitive
10. Numanoglu C, Guler S, Ozaydin I, Han A, Ulker V, Akbayir O.
method for the detection of an ovarian tumor.
Stromal luteoma of the ovary: A rare ovarian pathology.
J Obstet Gynaecol 2015;35:420-1.
REFERENCES
How to cite this article: Akhtar K, Saeed N, Alam S,
1. Berek JS. Berek and Novak’s Gynecology. 15th ed. Philadelphia, Jabin S. Stromal Luteoma of the Ovary: A Rare Case
PA: Lippincott Williams and Wilkins; 2010. p. 461-6.
Presentation. J Pathol Infect Dis 2020;3(1):1-3.
2. Haji AG, Sharma S, Babu M. Androgen secreting steroid cell